Abstract 17686: Effects of Cystatin C Levels on Angiographic Atherosclerosis Progression and Clinical Events Among Post Menopausal Women: Data from Women's Angiographic Vitamin and Estrogen (WAVE) study

Abstract

Background: End-stage renal disease and mild renal insufficiency are associated with increased cardiovascular risk. Cystatin C, novel marker of kidney function, was found to be associated with higher cardiovascular events and mortality independent of Glomerular Filtration Rate (GFR). However, it remained uncertain where enhanced cardiovascular risk associated with cystatin C is due to rapid atherosclerotic plaque dvelopment or due to plaque instability. This study examined the effects of baseline cystatin C on angiographic atherosclerosis progression and clinical events.

Methods: 423 postmenopausal women with angiographically documented CAD were randomized in the Women’s Angiographic Vitamin & Estrogen trial. Baseline renal function was determined based on cystatin C and creatinine. Coronary angiograms were performed at baseline and after 2.8 ± 0.9 years and quantitative coronary analysis performed at core laboratory. Clinical events were recorded during the follow up. For the present study angiographic progression of disease and clinical events among postmenopausal women with cystatin C levels in lower three quartiles were compared to those with cystatin C levels in the highest quartile.

Results: Women with Cystatin C levels in the highest quartile were older and more likely to have CHF and stroke. Annualized change in lumen diameter was similar between two groups at diseased ([[Unable to Display Character: &#8710;]] minimal lumen diameter -0.008 ± 0.10 vs -0.017 ± 0.21, p=0.74) and at non-diseased segments ([[Unable to Display Character: &#8710;]] minimal lumen diameter -0.035 ± 0.14 vs -0.030 ± 0.14, p=0.90). All cause death/ MI (3.6% Vs15.6%, p<0.001), cardiovascular death/ MI (2.3% Vs 13.5%, p<0.001) and cardiovascular events (3.6% Vs 13.5%, p<0.001) were significantly higher among women with cystatin C in the highest quartile. The risk of clinical events associated with cystatin C remained significantly higher in multivariate logistic regression analysis after adjustment with baseline differences,cardiovascular risk factors and GFR.

Conclusion: Among post menopausal women with angiographically documented CAD, baseline cystatin C level was not associated with angiographic disease progression, suggesting that other factors such as plaque instability may contribute to worse clinical outcome.